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To investigate the role of ultra-widefield fluorescein angiography (UWFA) for monitoring therapeutic response to adalimumab in patients with Behcet's uveitis.Patients with Behcet's uveitis treated with adalimumab for ≥30 weeks were included. Intraocular inflammation, best-corrected visual acuity, systemic medications, and UWFA scores were evaluated.Thirty-eight eyes of 20 patients were included. Significant decreases in grading of anterior chamber cells and vitreous haze were observed at 6, 14, and 30 weeks after adalimumab administration (UWFA scores significantly improved in Behcet's uveitis patients treated with adalimumab, and further improvement of UWFA scores was found in patients with a clinically quiescent inflammatory state.

Purpose: To evaluate subfoveal choroidal thickness (SCT) changes and ocular inflammation after pars plana vitrectomy (PPV) in Vogt-Koyanagi-Harada (VKH) disease.Methods: We analyzed best-corrected visual acuity (BCVA), ocular inflammation, complications, and SCT in 17 eyes of 14 patients with VKH disease who underwent PPV and had ≥12-month follow-up. Main surgical indications included vitreous opacity, epiretinal membrane, and macular hole.Results: Mean BCVA showed significant improvement at all time-points after PPV. Mean SCT significantly increased up until 3 months after PPV (P = .001), but returned to baseline at 12 months and was lower than baseline at the final visit (P = .025). Mean acute uveitis relapse rate decreased after PPV (P = .008). SCT increase was greater in the nine eyes with postoperative uveitis recurrence than in those without (P = .043).Conclusion: Vision improved after PPV in patients with VKH disease. SCT increase in the early postoperative period was associated with uveitis recurrence during follow-up, suggesting that vitrectomy may induce choroiditis after PPV in VKH.

To compare the clinical features and treatment outcomes of different types of vitreoretinal lymphoma (VRL) that presents primarily, secondarily, or concurrently in association with CNS lymphoma.We retrospectively reviewed the medical records of 53 patients with VRL pathologically confirmed between 2000 and 2014 in two of the largest tertiary hospitals in Korea.The proportions of primary, secondary, and concurrent VRL were 26%, 34%, and 40%, respectively. The primary VRL group had retinal infiltration most frequently (68%) among all groups and presented with the worst visual acuity at diagnosis (P = 0.035). The diagnostic delay was significantly shorter in patients with secondary VRL (1.4 months; P 0.001). Median overall survival was 31 months in the entire cohort, and it was shortest in the concurrent VRL/CNS lymphoma group (18 months; P = 0.007).Ocular presentation and survival times may be different in VRL patients according to the association with CNS involvement.

Purpose: To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period.Methods: We reviewed data from 128 eyes of 60 American and 48 Korean patients diagnosed with EE and compared their clinical characteristics.Results: Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision.Conclusions: The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.

Purpose: To test inter-observer agreement in applying the scoring system of the Angiography Scoring of Uveitis Working Group (ASUWG) to ultra-wide-field fluorescein angiograms (UWFA) obtained from patients with Behcet retinal vasculitis.Methods: Both standard FA and UWFA images were obtained from 21 patients with retinal vasculitis associated with Behcet disease. Three graders independently graded 21 series of standard FA and 21 series of UWFA images. Spearman rank correlation and the intra-class correlation coefficient (ICC) were used to analyze the correlations.Results: Total scores of all angiographic signs observed in both UWFA and standard FA images were significantly correlated between each pair of graders and among the three graders (ICC of standard FA = 0.874, p

Purpose: To investigate the change in nationwide incidence of endophthalmitis following cataract surgery in Korea from 2002 to 2013.Methods: From a national sample cohort (n = 1 025 340), c...

Purpose: To evaluate the additive effect of intravitrial triamcinolone (TA) injection in uveitic macular edema compared to systemic anti-inflammatory treatment only.Methods: Patients were randomized into the intravitreal TA injection group and the sham group. All patients received systemic anti-inflammatory treatment with follow-up monthly to 6 months, with additional treatment as needed.Results: Fifty eyes of 50 patients were enrolled. Central foveal thickness decreased significantly from month 1 in the TA group, and from month 3 in the sham group. Parafoveal area thickness significantly decreased in both groups from month 1, with greater decrease in the TA group at months 2 and 3. Leakage area on fluorescein angiography was significantly smaller in the TA group at months 1 to 3. Intraocular pressure increased in the TA group at months 1 and 2.Conclusions: Intravitreal TA injection showed earlier reduction of leakage and retinal edema compared to systemic anti-inflammatory treatment alone.

Purpose: To evaluate long-term changes of subfoveal choroidal thickness (SCT) in Behcet’s disease (BD) patients with posterior uveitis.Methods: Changes in SCT measured with enhanced depth imaging optical coherence tomography during quiescent phase were assessed during >24 months in 63 BD patients and control group.Results: Baseline characteristics showed no difference, but the BD group showed poorer visual acuity (p = 0.013) and smaller SCT (p = 0.006) at final examination. Mean SCT in the BD group decreased from 291.0 to 268.1 μm (p

Purpose: To evaluate the efficacy of combined trabeculectomy (TLE) and 25-gauge transconjunctival sutureless vitrectomy (TSV-25) for uveitis patients.Methods: Combined TSV-25/TLE was performed in 9 eyes of 6 patients with vitreoretinal complications and intractable glaucoma. Visual acuity, intraocular pressure (IOP), inflammatory control, and number of hypotensive medications were evaluated.Results: Visual acuity improved in 7 of 9 eyes and inflammation was controlled with a decreased oral anti-inflammatory agent dosage in all eyes. Mean IOP, which was 28.11 ± 4.83 mmHg preoperatively, was significantly reduced (15.77 ± 2.68 mmHg) 5 years after surgery (p = 0.008). The mean number of IOP-lowering medications was 3.33 ± 0.71 before surgery and 1.11 ± 0.92 5 years after surgery (p = 0.007). Two eyes required implant of an Ahmed drainage valve during the follow-up period.Conclusion: Combined TSV-25/TLE can be effective in managing vitreoretinal complications and elevated IOP in uveitis patients.

To evaluate the long-term efficacy and safety of intravitreal triamcinolone acetonide (IVTA) injection for posterior segment inflammation in Behçet disease (BD) patients.The authors reviewed the medical records of BD patients who underwent IVTA injection (4 mg/0.1 mL) for posterior uveitis attack unresponsive to systemic immunosuppression and were followed up for more than 24 months.Forty-nine patients (49 eyes) were included. Mean best-corrected visual acuity improved from 0.89 logMAR units to 0.70, 0.64 at 12, 24 months, respectively. Complete inflammation control was achieved in 87.0% of patients, but 60.0% of them experienced relapse within 12 months. For phakic eyes, cumulative probabilities for cataract surgery were 13.8%, 48.9%, and 60.2% at 12, 24, and 36 months, respectively. Intraocular pressure elevation exceeding 21 mmHg was noted in 40.8%.In Behçet uveitis attack that is unresponsive or intolerant to systemic medications, IVTA injection is an effective therapeutic option, although ocular complications could limit its efficacy and repeatability.

To evaluate the safety and efficacy of gevokizumab for the treatment of Behçet's disease uveitis in a prospective, open-label, randomized phase 2 trial.Behçet's disease patients with new acute ocular exacerbation or at risk of exacerbation received 30 or 60 mg gevokizumab every 4 weeks intravenously or subcutaneously, on top of a stable regimen of immunosuppressives and corticosteroids (≤20 mg/day equivalent prednisolone). Patients withdrew in cases of ocular exacerbation.A total of 21 patients were included (17 acute and 4 at-risk; mean duration of uveitis 45.6 ± 37.4 months). There were no serious adverse events related to gevokizumab. Recorded adverse events were mostly associated with exacerbation of uveitis or its complications. Response was evaluated for 14 acute patients and all showed rapid control of acute ocular exacerbation, mostly within 1 week, without any increase in corticosteroid dosage.Gevokizumab was well tolerated and rapidly controlled acute ocular exacerbations of Behçet's disease uveitis without the need for high-dose corticosteroid.

To determine the association of fluorescein angiography characteristics with visual acuity and visual loss during medical treatment in patients with Behçet uveitis.Ninety-three eyes from 69 Behçet patients with active panuveitis underwent fluorescein angiography, and the characteristic findings by angiography were determined. The patients were followed with immunomodulatory treatment.Diffuse vascular leakage (73.4%), diffuse macular leakage (66.0%), and disc leakage (52.7%) were the predominant angiographic findings on fluorescein angiography. Multivariate logistic regression analysis revealed that a macular window defect and disc neovascularization on fluorescein angiography were associated with poor visual acuity (or= 20/200) (p.05). The presence of macular ischemia on fluorescein angiography was significantly associated with the risk of visual loss (or= 20/200) at 48 months post-treatment (p.05).These results suggest that fluorescein angiography may be helpful for predicting visual prognosis for Behçet patients with panuveitis.

To evaluate treatment outcomes with low-dose azathioprine in Vogt-Koyanagi-Harada (VKH) disease patients.Retrospective case series.Medical records of consecutive patients with VKH disease were reviewed. Azathioprine was administered in cases with corticosteroid intolerance or uncontrolled inflammation. Corticosteroid sparing effect, visual acuity, corticosteroid dose, and complication rates were evaluated.Sixteen of 34 VKH patients included in this study underwent azathioprine therapy with systemic corticosteroid. Six patients received azathioprine in the acute uveitic phase and 10 patients in the chronic recurrent phase. A corticosteroid sparing effect was achieved in 86.5% of patients given azathioprine in the acute uveitic phase and 90.0% of patients given in the chronic recurrent phase. Median time to corticosteroid sparing effect was 3.5 months. Twelve of 16 patients showed improved activity in 1 month after initiation of azathioprine therapy.Low-dose azathioprine therapy may be effective as corticosteroid sparing agent in VKH disease.

Purpose: To assess discrepancies between fluorescein angiography (FA) and optical coherence tomography (OCT) findings for macular edema (ME) in intermediate uveitis, and investigate treatment response differences corresponding to the discrepant patterns.Methods: Discrepant results for ME detection between FA and OCT were evaluated. After 6 months, differences in treatment responses were analyzed.Results: Discrepant findings for ME were found in 21 (44%) of 48 eyes. The best-corrected visual acuity significantly improved after treatment in the concordant group but not in the discrepant groups. Central retinal thickness significantly decreased after treatment in the FA+/OCT+ and FA−/OCT+ groups but not in the FA+/OCT− group. Disease duration was significantly longer in the FA+/OCT− group than in the other groups.Conclusions: Discrepancies in FA and OCT findings for ME were common in patients with intermediate uveitis. Our results suggest that treatment outcomes may differ according to the discrepant...

To investigate the association between cytomegalovirus and idiopathic chronic recurrent anterior uveitis with ocular hypertension.Medical records of 9 consecutive immunocompetent Korean patients with chronic recurrent anterior uveitis and ocular hypertension were retrospectively reviewed. Nested polymerase chain reaction was performed on aqueous humor samples for the herpes family, including cytomegalovirus, varicella zoster virus, herpes simplex virus, and Epstein-Barr virus.In 7 (77.8%) of 9 patients, aqueous samples were culture-positive for cytomegalovirus (n = 6), Epstein-Barr virus (n = 2), and/or varicella zoster virus (n = 2). Two patients with cytomegalovirus had corneal endotheliitis, and 2 patients with varicella zoster virus had sectoral iris atrophy.Cytomegalovirus is the most common cause of idiopathic chronic unilateral anterior uveitis with ocular hypertension in immunocompetent Korean patients. The authors suggest that performing polymerase chain reaction on aqueous samples is useful in diagnosing cytomegalovirus in these patients.

Purpose: To report a case of cytomegalovirus (CMV) endotheliitis after insertion of an intravitreal fluocinolone acetonide (Retisert) implant. Design: Interventional case report.Methods: Retrospective chart review.Results: A 40-year-old man received a Retisert implant in the left eye for recurrent Behcet uveitis. Although inflammation became quiescent within a month, corneal edema developed 4 months after insertion. Polymerase chain reaction analysis for aqueous humor detected 3.9 × 104 copies/mL of CMV DNA. After treatment with oral valganciclovir, CMV DNA nearly disappeared but visual outcome was poor due to corneal decompensation resulting from severe endothelial cell loss.Conclusions: After Retisert implant, clinicians should be attentive to the potential risk of CMV endotheliitis.

Purpose: To compare clinical characteristics and visual prognosis between HLA-B27-associated uveitis patients with and without posterior segment involvement. Methods: Medical records of 78 patients with HLA-B27-associated uveitis were retrospectively analyzed. Results: Neither demographic nor clinical characteristics were associated with the presence of posterior segment involvement. In patients with posterior segment involvement, more aggressive therapeutic strategies, including immunomodulatory therapy, were frequently required. The rate of visual acuity 20/50 or worse was higher in patients with posterior involvement than in patients without posterior involvement. Conclusion: Patients with posterior segment involvement showed worse visual outcome than patients without posterior involvement.

To investigate the changes of effector-related phenotypic markers and the natural killer (NK)-like effector functions of CD8(bright)CD56+ T cells in patients with Behçet uveitis after combined cyclosporine and prednisone (Cs/Pd) treatment.Ten patients with active Behçet panuveitis and 10 healthy controls were prospectively recruited in this study. The effector-related surface markers (CD27, CD62L, CD11b, HLA-DR, CD94, NKG2D), chemokine receptors (CXCR1, CXCR3, CCR4, CCR5), and intracellular perforin of circulating CD8(bright)CD56+ T cells were determined by flow cytometric analysis before and after two months' treatment. NK-like cytotoxicity of ex vivo CD8(bright)CD56+ T cells against K562 was measured by standard 51Cr release assay.The expression levels of effector-related molecules on CD8(bright)CD56+ T cells normalized after treatment. The expression levels of CXCR1 and CCR5 were down-regulated on CD8(bright)CD56+ T cells after treatment. The amounts of preformed intracellular perforin of CD8(bright)CD56+ T cells were reduced to the normal levels. Furthermore, the NK-like cytolytic capacities of CD8(bright)CD56+ T cells were decreased after treatment.Our results suggest that the combined Cs/Pd treatments in active Behçet uveitis may downregulate the NK-like effector functions of CD8(bright)CD56+ T cells.

To determine whether vitrectomy is safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent panuveitis.Patients who had undergone therapeutic vitrectomy for Behçet's panuveitis were reviewed retrospectively. Those patients who had shown persistent uveitis despite maximum medical therapy were included. Surgical outcomes were measured by an improvement in vision of 0.3 logarithm of minimum angle of resolution, acute relapse rates, and postoperative complications.Twenty-one patients with a mean postoperative follow-up of 30 months were identified. For almost all patients visual acuity and inflammatory control were significantly improved after vitrectomy. However, patients with optic disc neovascularization (NVD) showed no improvement in their vision or inflammatory control. The postoperative rise of intraocular pressure was frequently associated with intravitreal triamcinolone acetonide injections.Our study suggests that vitrectomy may be both safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent uveitis. Patients with NVD, however, may have poor outcomes.